Claims Apprentice – Workers Compensation

The Claims Apprentice will be trained in-house by PMA’s team of Workers’ Compensation claims experts. During the course of the training program, the Apprentice is expected to continuously develop their skills and knowledge and assume and resolve a caseload of workers’ compensation claims, of increasing complexity, in a timely manner and in accordance with legal statutes, policy provisions, and company guidelines.
Essential Functions

• Promptly investigates all assigned claims. Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable). Alerts Supervisor and Special Investigations Unit to potentially suspect claims. Ensures timely denial or payment of benefits in accordance with jurisdictional requirements.
• Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure. Negotiates claims settlements within granted authority.
• Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition. Works collaboratively with PMA nurse professionals to develop and execute return to work strategies.
• Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome.
• Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced.
• Demonstrates technical proficiency through timely, consistent execution of best claim practices.
• Communicates effectively, orally and in writing with internal and external parties on a wide variety of claims and account issues. Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions.
• Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department. Assists PMA clients by suggesting panel provider information in accordance with applicable state statutes.
• Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.

Requirements

• Bachelors’ degree required.
• 1-3 years of equivalent work experience, in a service-oriented role, is preferred.
• Familiarity with medical terminology and/or Workers’ Compensation preferred.
• Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously.
• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details.
• Excellent verbal and written communication skills.
• Excellent customer service skills gained through previous work experience.
• Ability to remain calm under duress and maintain a professional demeanor at all times.
• Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint and an ability to learn PMA’s Claims system.
• Willingness to travel for business purposes; Travel less than 10%.